Provider Demographics
NPI:1811740467
Name:KILCLINE, TIFFANY ANN (COTAL)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:ANN
Last Name:KILCLINE
Suffix:
Gender:F
Credentials:COTAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17631 LOWELL ST
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-2807
Mailing Address - Country:US
Mailing Address - Phone:586-381-1196
Mailing Address - Fax:
Practice Address - Street 1:17631 LOWELL ST
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-2807
Practice Address - Country:US
Practice Address - Phone:586-381-1196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-11
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant